Smartphone applications for surveillance of Gestational Diabetes: A Scoping Review (Preprint)

Abstract

BACKGROUND Telemedicine offers a promising solution to the healthcare demands associated with the increasing prevalence of gestational diabetes (GDM). Due to near pervasive levels of smartphone ownership and advances in capabilities of information and communication technology, app-assisted healthcare can facilitate the remote surveillance of important parameters of GDM care. The maintenance of hospital oversight of patients engaging in app-based care is paramount to ensure identification of sub-optimal glycaemic control, compliance with self-monitoring schedules and provision of accurate and accessible educational resources. OBJECTIVE We sought to identify studies evaluating feedback performance of smartphone app-assisted healthcare programmes enabling the remote surveillance of gestational diabetes. The assessment and achievement of glycaemic control following adoption of such app-assisted healthcare delivery programmes was our primary outcome measure. Secondary outcomes included patient and staff satisfaction levels and cost effectiveness of app-based interventions. METHODS A comprehensive search of the electronic databases Pubmed, Embase, CINAHL, Web of Science and the Cochrane library was performed. Two independent reviewers screened the titles and subsequently selected and reviewed eligible studies. The initial search yielded 954 references. De-duplication and removal of irrelevant studies identified 105 studies for full text screening. Ultimately, 17 studies exploring feedback related app-assisted healthcare among 1891 patients with GDM met criteria for inclusion in the final review. RESULTS All seventeen reviewed studies facilitated direct uploading of glycaemic data from the glucometer to the smartphone app. Other variables captured by the described apps included diet and exercise patterns, blood pressure, ketonuria and heart rate. Bidirectional communication was the most commonly employed contact strategy between app-users and their hospital care teams. Feedback was facilitated through the app interface in an automated manner or by personal staff to patient messages in the remainder. Rates of adverse maternal or neonatal outcomes were not affected by app-users. Satisfaction with app-based management was overwhelmingly positive for both app-users and their obstetric diabetes teams. Economic assessment and resource utilisation were only explored in five studies, however, evidence in favour of benefit for app-assisted surveillance was the predominant outcome. CONCLUSIONS This scoping review provides a comprehensive overview of the availability and functionality of smartphone applications capable of the generation of remote feedback in the surveillance of women with gestational diabetes. The evidence collated by this review demonstrates equivalent or improved glycaemic control among women engaging in smartphone app-assisted healthcare for GDM surveillance. Incorporation of smartphone app-based surveillance is feasible and acceptable with beneficial effects envisaged from an economic and resource availability perspective.